Doctor to many, mother to three, wife to one. I run, I blog, I cross-stitch.

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Life Imitates Art.

I have always been a sucker for disaster movies. If I’m laid up on the couch sick with the flu, or just need a go-to movie to watch, my husband always knows which film to put on. Hollywood doesn’t disappoint – there are many to choose from, be it in the form of natural disasters like comets and asteroids threatening the Earth, or solar flares, or climate change causing another ice age – I have my pick of movies that I can watch over and over and over again.

There’s a certain suspension of reality from the movies I’ve listed below – how likely is it that we will see another ice age? I mean, really. How likely is it that a comet or asteroid is suddenly going to be discovered that will hit us in just the right way to cause an extinction level event? I always joked that if such a thing were to ever happen, I would want a front seat to watch it. A giant asteroid hurtles towards the Earth and will destroy the planet? Yes! Sign me up for a front row seat to watch it enter the atmosphere!

But then there’s the other kind of disaster movie. The movie about a virus, spreading throughout a population. There’s only been a few that I can think of, probably because it hits a little too close to home for most people. You know the movies. You’ve seen them.

These movies are a little harder to watch, especially Contagion. Why? I think that’s pretty much self-explanatory. The likelihood of a virus causing illness and spreading quickly, infecting and potentially killing people, is well documented in human history.

The Black Death (aka the Second Plague) killed an estimated 75-200 million people in the 14th century. It was caused by a bacterium called Yersinia pestis and was carried by rats. Also known as the Plague, it ravaged most of Europe, and took almost 150 years for Europe’s population to recover. The Plague recurred on and off for the next 500 years, causing smaller outbreaks in Spain, France, Sweden and Russia.

Smaller pandemics of cholera, typhus, measles and smallpox have been reported throughout the past 1,000 years:

The Italian Plague killed 280,000 people in the 1600s

In Southern New England, 30-90% of the population of the Wampanoag people died of leptospirosis

In the 17th century, the Great Plague of London killed an estimated 100,000 people

In Asia/Europe, in the early 1800s – the first cholera pandemic killed over 100,000 people

The second cholera pandemic, in the mid 1800s, killed another 100,000+ people in Asia, North America and Europe

In 1838, over 100,000 people died in the smallpox epidemic of the Great Plains

The third cholera pandemic affected Russia killed 1,000,000 people in the span of 8 years, between 1852-1860

20,000+ people died of a typhus epidemic in Canada, in 1 year in 1848

In 1875, 40,000 people died of measles in Fiji

Worldwide, in 1889, 1,000,000 people died of a flu pandemic

The 20th century alone saw some of the world’s worst pandemics.

The Spanish flu decimated the world’s population after WWI, killing an estimated 75,000,000 (75 millon) people, in 2 years!

In 1957, the Asian flu killed 2,000,000 people worldwide.

1 million people died in 1968 of the Hong Kong flu.

15,000 people died in India, in 1974, of cholera

More than 30,000,000 people have died of HIV/AIDS since 1981

The 21st century is almost a decade and a half old. We have seen our fair share of outbreaks. Nothing as devastating as in the past, thanks mostly to sanitation, vaccination, antibiotic and antiviral medication, but outbreaks nonetheless. One might argue that the world is due for one.

In 2003, SARS killed 775 people, mostly from China, Hong Kong and Canada; it spread to 37 countries from China

The 2009 flu pandemic (H1N1) killed about 15,000 people worldwide.

And this brings me to the real reason for this post.

For months now, news of the Ebola epidemic in West Africa has filtered through my Twitter and Facebook feeds. The numbers of infected are astounding. I’ve seen estimates that by January 2015, over 1 million people will be infected, half of whom will die. Ebola, historically, has had 90% death rate. During this recent epidemic, about half of people infected are dying. But that is still 50% case fatality rate.

So, what is Ebola? And why is it so deadly? Well, Ebola is a virus. It’s actually quite pretty, I think.

My knowledge of virology is limited to a few hours of lectures on viruses from medical school. It has an RNA-genome and it is kind of long for a virus. Like most viruses, Ebola enters a cell by attached to that cell’s protein coat and fusing with it. Once fusion of the two occurs, the virus empties it’s contents in the cell and the RNA attaches to the host cell’s RNA and takes over. Instead of the cell making its own proteins, it now has instructions from the viral RNA and starts making copies of the virus. Once those copies are made the virus attaches to the cell’s outer coat, buds with it and leaves the cell. By this time, the cell usually cannot function anymore, and so it dies. The new virus copies get into the bloodstream where they are free to infect other cells and the cycle starts again. The host immune system cannot keep up with this invader. The virus makes special proteins that interfere with the hosts’ defenses and leaves the host vulnerable.

The Ebola virus especially likes the cells that line the blood vessels, as well as certain cells of the immune system and the liver. After infecting these cells, it damages the integrity of the vessels, leaves the immune system’s defenders weakened, and damages the liver’s ability to form clotting factors. The host then starts to bleed internally, hence the reason Ebola virus infection is also known as hemorrhagic fever. The host bleeds internally, eventually causing death.

By the grace of God, if you so believe, Ebola virus is not airborne. This means that it’s not present in the air and cannot be transmitted from being coughed on, sneezed on, or breathed upon. Infection with Ebola occurs when bodily fluids (blood, feces, urine, emesis) from an infected host are mixed with a healthy host. Most of the people who have gotten sick in Africa were family members and health care workers caring for the sick, and sadly, the dead. The WHO recommends avoiding contact with the sick whenever possible, regular hand washing with soap and hot water, and discourages traditional funeral rites of washing and embalming the bodies of the dead. The virus can be killed with heat (heating for 30 to 60 minutes at 60°C or boiling for 5 minutes). Quarantine remains an effective method of controlling the disease.

I’ve often joked with friends and family that the world is due for a pandemic. It’s been almost a hundred years since the Spanish flu pandemic. The seasonal flu is nothing to joke about – the very young and the very old, still die every year from regular, joe-schmoe influenza. There is a vaccine developed every year against the strains that most likely will be in circulation. Since 2009, the vaccine now protects again H1N1 as well. Our office is getting ready for our annual fall classic – the Flu shots are arriving tomorrow and we are starting “flu shot” clinics next week.

But something in the news recently has me a bit worried. Earlier this week, it was reported that a traveller from West Africa boarded a plane in Liberia and landed in Dallas, Texas. Asymptomatic at the time, he passed through whatever checkpoints were in place and entered U.S. soil. A few days later, he started getting sick and presented himself to the local ER. He told the triage desk his travel history, was seen by a doctor, given a script for antibiotics and was sent home. He returned to the hospital 4 days later, very ill, and was diagnosed with Ebola virus.

Yes, folks. Ebola virus is now in North America.

I have one question.

How the FUCK did this happen?!?!?

Why are planes from West Africa being allowed to land? If such a plane does land, why aren’t those travellers being immediately quarantined and monitored for symptoms? Have we learned nothing from SARS and H1N1?

I wouldn’t want to be that triage nurse in Texas who took the travel history information from the Ebola patient and failed to forward it along to the attending physician. I’d like to think that physician, had he known his patient had recently been in Liberia where there is an Ebola outbreak occurring, would have immediately notified the Centers for Disease Control and Prevention (CDC), and locked down his hospital. But no, that physician apparently didn’t know of the travel history, the patient didn’t bother to mention it again, and he was sent along his merry way to infect his family and God-knows who else.

Apparently, the man went back to the apartment complex where his family lived, started getting progressively more sick, was actually seen vomiting outside the building before being taken back to the ER where he was eventually diagnosed. Does this not alarm anyone? When I read the news report to my husband, he made an interesting observation. One that actually is a bit frightening.

Who cleaned up the vomit which likely was teeming with Ebola virus?

Did a dog come by and lick the vomit? Did that dog go back to his owners? Is the dog sick? What will Ebola do in a new host species? Has the virus mutated? Can it become airborne?

According to that report yesterday, 18 people have been identified as being in contact with this individual.

Today? The Texas health departmentt said there were 100 potential contacts. “Dallas County officials said more than 80 had direct or indirect contact with the patient.”

Well, which is it? Indirect contact shouldn’t be a concern with Ebola, right? Only direct contact, like family members cleaning up vomit or feces, or wiping the face of their sickened family member; or the maintenance worker of the apartment complex told by his bosses to clean up the vomit outside the building?

Today it’s 100. Tomorrow it could be 1000.

Is this the beginning of next pandemic I joked earlier I thought we are due for?

In those two movies I love to watch, Outbreak and Contagion, the CDC takes control of local health departments and gets the epidemic under control. Is life about to imitate art?

We had a “suspected case” in one of our hospitals last week – based solely on travel history and symptoms and they locked down the ER for 6 hours… No one in or out. Obviously (since it wasn’t on the news), it was not Ebola. But I agree with you – who dropped the ball???

I’m not sure but it seems to me the travel history wasn’t conveyed to the right people. The patient told a nurse (presumably?) where he had come from but that info got lost along the way. They let a person with active symptoms of Ebola (at that time it was a fever and flu-like illness) out into the community to infect God-knows how many people. Scary stuff!

This is a good (and frightening) example of why physicians should always ask about travel history. Like you, I’d like to think that had the physician known the man had just come from Liberia, he wouldn’t have sent the man home.

I ask my patients about travel history all the time and in most cases I get an irritated look as if they’re thinking, “Do I have time/money/inclination to travel?” lol! I had a fantasy this morning about asking such a question to a patient with flu-like symptoms in my office and thought of what I’d do if they replied, “Liberia”. I would lock down the office, gown and mask everyone and pray.

Thank you! I’ve been following Michael C. Gibson on twitter and it’s a little alarming to me that that CDC did not take care of sanitizing the Ebola patient’s apartment, but hired some company to do it. I’ve put the link up on my Twitter account. Frightening.

And I just heard this morning that a patient is in quarantine at one of our downtown hospitals that handles most infectious disease cases. The patient is being tested for Ebola but I haven’t heard yet of the results.

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Disclaimer

Any office scenarios described here have been altered to protect the patient's privacy. This blog is not intended to offer clinical advice. If you are concerned about your health, get off Dr. Google and please go see your doctor. Any similarity to any person living or dead is merely coincidental.

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